Major Advances in Musculoskeletal Imaging

How Yale Medicine has pioneered medical imaging technologies for musculoskeletal conditions

Musculoskeletal Imaging

Credit: Peter Otis

Yale Medicine has been a pioneer in the field of imaging since physicist and Yale Professor Arthur W. Wright took the very first X-ray in the Americas in 1896. Wright accurately predicted that X-rays would someday be harnessed in service of medical imaging, and that the technology would soon be used to examine the internal structures of the human body.

Today, even early proponents such as Wright might be surprised by the success, exponential growth and refinement of medical imaging. Doctors now use X-rays, magnetic resonance imaging (MRI), nuclear medicine, ultrasound and related imaging methods as a cornerstone of health care. Wright would likely be proud to know that Yale Medicine’s Musculoskeletal Imaging Section, in the Department of Radiology & Biomedical Imaging, consistently has been a leader in the use of those imaging technologies for diagnosis, treatment and research.

Yale Medicine’s Musculoskeletal Imaging Section provides a comprehensive array of tests. Each of our radiologists is a specialist, with extensive education and experience in his or her specialty. Our radiologists collaborate closely with research teams and participate in cross-departmental conferences, including monthly meetings focused on using the MRI in sports medicine and weekly conferences to review cases involving tumors.

Waves of advances

One of the most significant trends in imaging at Yale kicked off in 1989, when Lee Katz, MD, co-director of the Musculoskeletal Imaging Section, started Yale Medicine’s work in MRI arthrography. At the time, this was a new way of using magnetic resonance imaging to diagnose conditions in the knees, shoulders, hips and other joints. In the years following, Dr. Katz was among the pioneers in offering a refined version of the technology—adding contrast agents to improve the precision of images.

Today, we're at the forefront of advances in the use of 3-D printing for orthopaedic surgery. James Elliott Brown, MD, co-founder and director of 3-D Printing at Yale Medicine, says 3-D printing’s primary value is in helping surgeons to visualize anatomical anomalies that are rarely seen and which may be hard to understand from conventional imaging alone.

Yale Medicine prints its own 3-D models with the help of a dedicated technologist trained specifically in the creation of models for surgical planning. The 3-D models are also helpful for patients, since they can provide concrete information on what's going on inside their bodies so they can ,make sense of their surgeon's treatment recommendations. "Seeing a 3-D model, you have a better understanding of what's going on and why a certain procedure might be helpful," says Dr. Brown. "It helps patients make more informed decisions about their health care."

Real-time imaging improves diagnoses 

Another of the marvels of medical imaging is using computerized tomography (CT) scanning to improve the quality of bone marrow biopsies. Years ago, a bone biopsy required hospital admission, general anesthesia and surgery. 

Today, the radiologist performs a percutaneous bone biopsy. This involves inserting a bone biopsy needle through the skin and into the bone. This is a non-surgical way to withdraw solid elements of the bone marrow. It has many advantages. The physician can look at the scan in real time during the procedure. The patient can elect to have conscious sedation rather than general anesthesia. In this way, "the patient can have the biopsy and go home the same day,” says Dr. Katz.

Following the biopsy, a bone pathologist, medical oncologists, therapeutic radiologists and members of the Musculoskeletal Imaging Section and the Orthopedic Surgery Oncology group meet as a team to go over the results. “This combined team effort leads to improved communication among the participating physicians, and the best therapeutic plan for the patient,” Dr. Katz says.

The Musculoskeletal Imaging Section’s interventional radiologists also play an increasingly large role in performing bone marrow aspirations. It's a procedure similar to a bone biopsy, in which bone marrow liquid is extracted. Like bone biopsies, bone marrow aspirations are performed using CT guidance, with the patient under conscious sedation.

“These are patients being evaluated for hematologic malignancy, cancers beginning in the cells of blood-forming tissue,” Dr. Katz says. “We’re often looking at the response to therapy or the possibility of recurrence.” 

A wide range of procedures

The radiologists use numerous techniques and technologies to perform a wide variety of procedures. For instance, they use ultrasound, which is most commonly association with capturing images during pregnancy, to help diagnose a range of chronic conditions and injuries, including tendonitis, bursitis, carpal tunnel syndrome, rotator cuff tears, joint problems, and masses such as tumors or cysts. "Musculoskeletal ultrasound allows us to see in high resolution a person's muscles, tendons, ligaments, nerves and joints, says Risa H. Kent, MD, an assistant professor of Radiology and Biomedical Imaging at Yale School of Medicine. 

Radiologists even help treat people for arthritis. They inject a combination of steroids and anesthetics into the affected shoulder,  hip, knee or other joints, using a fluoroscope for guidance. Fluoroscopy uses a safe, low-dose continuous X-ray that gives the radiologist a clear view of the affected joints and surrounding areas, ensuring that the injection is targeted precisely. “Although these treatments do not cure a patient’s arthritis,” Dr. Katz says, “they can relieve the pain and discomfort, and put off an eventual total joint replacement."